Healthcare Provider Details

I. General information

NPI: 1255638300
Provider Name (Legal Business Name): HEALTH & REHAB CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W 5TH AVE
TALLAHASSEE FL
32303-6125
US

IV. Provider business mailing address

108 W 5TH AVE
TALLAHASSEE FL
32303-6125
US

V. Phone/Fax

Practice location:
  • Phone: 850-224-0033
  • Fax: 850-224-0033
Mailing address:
  • Phone: 850-224-0033
  • Fax: 850-224-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARLAINE RAYMOND
Title or Position: OWNER
Credential:
Phone: 850-224-0033